Anthony P. Furnary, MD
Potential Conflicts of Interest: None disclosed.
Furnary A.; Intensive Insulin Therapy in Hospitalized Patients. Ann Intern Med. 2011;154:845-846. doi: 10.7326/0003-4819-154-12-201106210-00019
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Published: Ann Intern Med. 2011;154(12):845-846.
TO THE EDITOR:
I read with interest Qaseem and colleagues' clinical practice guideline on intensive insulin therapy (IIT) (1). For diabetic patients who have undergone coronary artery bypass grafting (CABG), recommendations 2 and 3 are unfounded and not supported by the data cited.
Only 2 of the 14 randomized, controlled trials (RCTs) evaluated in the meta-analysis (2, 3) included patients who had undergone CABG. In both of these trials, IIT-directed tight glycemic control (TGC) statistically significantly reduced in-hospital mortality and surgical wound infection rates. All of the remaining studies that were evaluated in the meta-analysis excluded patients who had undergone cardiac surgery by design. Those studies should not be used to broadly “overrule” the statistically significant effects of ITT-TGC that have been repeatedly proven in diabetic patients who have undergone CABG. To dilute the positive effects of these 2 cardiac surgical RCTs with 12 medical or noncardiac surgical studies of IIT-TGC that were ineffective in reducing mortality and infection and then broadly claim that IIT-TGC should not be performed in all patients—including diabetic patients who have undergone CABG—is both irresponsible and dangerous.
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